Objective: Many of the prior mortality
studies on bipolar disorder have emerged primarily
from the larger health service groups, with a tendency
to focus on suicide alone. This study examines personal and clinical characteristics of bipolar
patients in Taiwan in order to identify the factors
associated with early natural death.

Method: Bipolar patients admitted to a
psychiatric hospital in Taiwan between 1987 and 2002
were retrospectively followed through record linkage
for cause of death. One living bipolar individual
was matched to each deceased patient as a control
subject for age, gender, and date of index
admission. Clinical data and the results of laboratory
examinations during the last period of hospitalization
were obtained through a review of medical records.

Results: In a total of 60 natural deaths, the
principal cause was circulatory disease (33.3%).
Conditional logistic regressions revealed that the
variables most strongly associated with natural
deaths were years of antipsychotic treatment prior to
the last visit (95% CI for odds ratio [OR] = 0.77 to 0.98), serum alanine aminotransferase levels
(95% CI for OR = 1.02 to 1.25), and leukocyte counts (95% CI for OR = 1.01 to 2.50). Years of
lithium treatment (95% CI for OR = 0.74 to 0.97) may
be substituted for antipsychotic treatment as a
protective factor.

Conclusions: Systemic inflammation
and nonhepatic tissue damage during the acute phase
of bipolar disorder may be risk factors for early
natural death. Psychiatric treatment, including
medication with antipsychotics or lithium, could be a
factor in protecting against early natural death.